Op-ed | Why we need an individual mandate
Published: Tuesday, October 9, 2012
Updated: Tuesday, October 9, 2012 07:10
Health care is a basic human right, and though the United States is still miles away from equity of access, “Obamacare” is a necessary step in the right direction. Romney’s explanation of his alternative plan in last Wednesday’s debate seemed to be, “Let’s keep all the good parts of Obamacare, but leave it up to each state to do what it wants.” The problem with this approach is that states may choose not to legislate an individual mandate, a controversial component of Obamacare that requires everyone to purchase health insurance or else pay a penalty. Among those exempt are people with financial hardship whose incomes are below the tax-filing threshold and for whom the cheapest plan costs more than eight percent of their income. Romney’s website cryptically addresses the individual mandate, stating that we must “end tax discrimination against the individual purchase of insurance.” Translation: He doesn’t like the individual mandate but doesn’t quite want to say so. The real question worth asking, though, is not about the individual mandate. It is the fundamental question: Is access to health care a basic human right? If it is, the individual mandate is necessary. Here’s why:
The biggest challenge to equal access is providing coverage for the poor. Without health insurance, people with low incomes tend to have more health problems because they lack access to preventive care. Their problems become so severe that they often end up in emergency rooms, incurring high costs that they are unable to pay. The poorest are covered by Medicaid, but the others place an enormous burden on hospitals, and in turn on taxpayers. For this reason, the individual mandate is particularly aimed at low- and middle-income people to make sure they obtain insurance coverage. If they have a medical disaster, the high costs fall on insurance companies, not on the individuals or taxpayers.
People buy insurance because medical emergencies and costs are unpredictable. Health insurance companies can only pay these costs by covering a large and varied population, most of which is healthy at any given time. The larger the healthy population is, the lower the premiums will be. If there is no individual mandate, some healthy people may choose not to buy health insurance because they don’t want to pay the premiums. They would rather risk getting sick.
In this scenario, there is a smaller pool of healthy people, so the insurance company must raise premiums to continue to cover the costs of the sick. If premiums go up, more healthy people decide to drop their coverage and this cycle, known as the death spiral, continues. In the private health insurance market, the plan goes out of business.
The individual mandate makes sure most people have health insurance, creating a large pool of healthy customers that drives down premium costs. Furthermore, by increasing preventive care, it makes people healthier, thereby reducing the burden of avoidable hospitalizations on taxpayers. This allows the government to allocate its resources to programs such as Medicaid that provide insurance for those who cannot otherwise afford it. If the United States is to catch up to most other high-income nations in protecting the right to equitable access to health care, we need to keep the individual mandate.
Ariel Branz is a sophomore majoring in community health. She can be reached at Ariel.Branz@tufts.edu. Adam Shoemaker is a sophomore majoring in community health. He can be reached at Adam.Shoemaker@tufts.edu.